Public health response needed to manage syphilis outbreak

The Royal Australasian College of Physicians (RACP) has written to the Associate Minister of Health, Julie-Anne Genter, calling on the NZ Government to urgently set targets and provide additional resources to tackle the syphilis outbreak affecting vulnerable communities across New Zealand.

Doctors also want the Ministry of Health to establish a promised electronic surveillance system that correctly notifies the number of syphilis infections.

“We are very concerned about the growing number of New Zealanders who are contracting syphilis infections, particularly in Auckland, where there is the highest rate of notified infections in the country – double the nation’s average,” said Dr Jeff Brown, RACP President (NZ).

“There are now cases of congenital syphilis, where the infection is being passed from a pregnant woman to her unborn baby. Without treatment, there can be serious and sometimes fatal complications for an infected fetus.

“In 2018, this simply shouldn’t be happening in New Zealand.”

In its letter to the Ministry of Health, the RACP highlights that syphilis has been a notifiable condition for 18 months, however, the Ministry is yet to implement an electronic surveillance system that correctly notifies the number of infections.

Sexual health clinics are notifying cases of syphilis to the Institute of Environmental Science and Research; however, the current surveillance system doesn’t include cases managed by primary care practitioners. Infection rates in the community are therefore likely to be higher, doctors say.

DHBs don’t have any targets when it comes to reducing syphilis infections or a national policy on workforce requirements for the sexual health sector (including medical, nursing, allied health professionals). Currently, there are no mandatory service specifications for the provision of publicly funded sexual health clinics.

“Syphilis doesn’t belong to a by-gone era, it’s here - particularly in vulnerable communities - it’s on the increase, and it’s entirely treatable and preventable with access to medicine, health services and regular screening,” Dr Brown said.

“The Ministry needs to urgently roll out the electronic surveillance system to monitor notifications, as well as set national standards for sexual health services. These public health services need to be adequately resourced to prevent and contain the spread of the disease.

“We are concerned that the absence of targets, workforce policy and service specifications combined with the reduction in specialist positions in Auckland will further contribute to the ongoing syphilis epidemic.”
Syphilis is a sexually transmitted disease that is caused by Treponema pallidum. It can usually be treated with antibiotics such as penicillin shots. Without treatment, syphilis can cause serious health problems.
Infected babies who aren’t treated can have seizures, brain damage, blindness, developmental delay, or die.
Since 2013, the number of infections has been steadily increasing across New Zealand and especially in Auckland.

The incidence for New Zealand in 2015 was 4.6 per 100,000 per year but was nearly twice as high in Auckland (8.7 per 100,000). Around 495 cases of syphilis were recorded in 2017.

Anyone can contract an infection. While 2015 data shows that infections have been most prevalent among gay and bisexual men of all ethnicities, in 2017 provisional data shows that 30 per cent of cases were diagnosed in the heterosexual population.
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